[ENT] Tonsillitis Flashcards
80% of pharyngitis cases are caused by?
viruses and are self-limiting
e.g. flu viruses, rhinovirus, coronavirus, RSV, EBV
20% of pharyngitis cases are caused by?
bacteria and may require abx
e.g. group A/C/G strep, mycoplasma, chlamydia and gonorrhoea
what are the features of infectious mononucleosis?
- fever
- wt loss
- maculopapular rash
- hepatosplenomegaly
how does mild acute tonsillitis present?
- freely tolerates fluids
- not clinically unwell
how is mild acute tonsillitis assessed?
- hx + exam
- Centor / FeverPAIN score (for abx guidance)
how do you manage mild acute tonsillitis?
- self care advice +/- PO abx
- swab if persistent / recurrent case
what are the components of the Centor criteria?
(+1 for each)
- age 3-14 (-1 point if >45)
- temp >38˚C
- tonsillar exudate
- cervical lymphadenopathy
- absent cough
what are components of the FeverPAIN score?
(+1 for each)
- fever in the last 24 h
- purulent tonsilitis
- attended within 3 days
- inflamed severely (tonsils)
- no cough or coryza
FeverPAIN 0-1
Centor 0-2
no abx advised
self care advice
FeverPAIN 2-3
“back-up” abx prescription
self care advice
FeverPAIN 4-5
Centor 3-5
abx prescription
self care advice
what abx can be prescribed for tonsilitis and for how long?
phenoxymethylpenicillin (penicillin V) for 5 days
2nd line / penicillin allergic: Clarithromycin / Erythromycin for 5 days
what are the features of moderate acute tonsillitis?
- unable to freely swallow fluids
- ‘hot potato voice’
- clinically unwell
how is moderate acute tonsillitis managed?
- IV abx
- IV dexamethasone
- fluids + analgesia
- bloods + glandular fever screen
- drain quinsy if present
after moderate acute tonsillitis is managed, what is done next?
observe for 3-4 hours, see if pt can tolerate fluids
if the pt with moderate acute tonsillitis can now tolerate fluids after mx, what is done next?
discharge home with PO abx and PO steroids
if the pt with moderate acute tonsillitis still cannot tolerate fluids after mx, what is done next?
continue abx + steroids
ENT referral
what are the features of severe acute tonsillitis?
airway compromise with trismus → EMERGENCY!
how is severe acute tonsillitis managed?
Emergency!
- high flow O2
- adrenaline nebs
- IV dex + abx
- bloods + glandular fever screen
- anaesthetic and ENT involvement
what is Ludwig’s Angina?
severe cellulitis involving the floor of the mouth, where swelling develops rapidly → tongue is displaced superiorly and posteriorly, blocking the airway
what are the causes of Ludwig’s Angina?
- deep neck space infections
- dental infection
- mandibular fracture
what are the features of Ludwig’s Angina?
- trismus
- stridor
- bilateral neck swelling
- SOB
how is Ludwig’s Angina managed?
urgent care with airway mx, IV steroids and abx
severe cases: I+D and intubation
what is the role of steroids (dexamethasone)?
reduces swelling and inflammation → relieves trismus, allows easier eating and drinking and resolves a ‘hot potato’ voice
drooling, stridor and tripod sitting in a toxic looking child. dx?
epiglottitis
bilateral cervical lymphadenopathy, fever, myalgia and testicular swelling. dx?
mumps
acrid/bitter taste in the mouth while eating, pain in the parotid/submandibular region. dx?
salivary duct stones
what is the 1st line ix for acute tonsillitis?
oropharyngeal examination
in suspected tonsillitis, pharynx must always be visualised for erythema, swelling and exudate
most common bacterial cause of tonisllitis?
strep pyogenes (group A strep)
